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Vol. 40. Issue 1.
Pages 17-19 (January 2004)
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Vol. 40. Issue 1.
Pages 17-19 (January 2004)
Original Articles
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Video-assisted Thoracoscopic Sympathectomy for the Treatment of Facial Blushing: Ultrasonic Scalpel Versus Diathermy
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M.A. Callejas
Corresponding author
7891mcp@comb.es

Correspondence: Dr. M.A. Callejas. Servei de Cirurgia Toràcica. Institut Clínic de Pneumologia i Cirurgia Toràcica. Hospital Clínic i Universitari. Villarroel, 170. 08036 Barcelona. España
, M. Rubio, M. Iglesias, J. Belda, E. Canalís, M. Catalán, J.M. Gimferrer
Servei de Cirurgia Toràcica, Institut Clínic de Pneumologia i Cirurgia Toràcica, Hospital Clínic i Universitari, Barcelona, Spain
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Objective

To evaluate the advantages of the ultrasonic scalpel compared to electrocoagulation in patients undergoing video-assisted thoracoscopic sympatholysis or sympathectomy for uncontrolled facial blushing.

Methods

Two hundred bilateral video-assisted thoracoscopic procedures to interrupt transmission in the thoracic sympathetic nerve were performed in 100 patients with incapacitating facial blushing. In 2 cases, the video-assisted approach was chosen because of pleural symphysis. The mean age of patients was 34 years (range: 15 to 67). The sympathetic chain was interrupted from the lower portion of the first thoracic ganglion through the third.

Results

All patients were discharged within 24 hours with the exception of one on whom an emergency thoracotomy had been performed. No complications were reported in the group in which a harmonic scalpel was used. One case of temporary Horner syndrome (4 months) and 3 cases of persistent chest pain (more than 2 weeks) were reported in the diathermy group. There were 9 cases of partial and asymptomatic pneumothorax that resolved without treatment or prolonged hospital stays.

Conclusion

Dissection of the sympathetic nerve is accomplished more reliably and with better visualization with the ultrasonic scalpel. Peripheral lesions in lung parenchyma and adjacent tissues (intercostal vessels and nerves) are avoided, as is Horner syndrome, which can be caused by dispersion of heat. Use of the ultrasonic scalpel would also lead to a lower incidence of postoperative neuralgia.

Key words:
Facial blushing
Video-assisted thoracoscopic sympathectomy and sympatholysis
Ultrasonic scalpel
Objetivo

Valorar las ventajas de la utilización del bisturí ultrasónico frente a la electrocoagulación, en los pacientes operados de rubor facial incontrolable mediante simpaticólisis o simpaticotomía torácica por videotoracoscopia.

Método

Se han realizado 200 interrupciones del simpático torácico bilaterales por videotoracoscopia en 100 pacientes afectados de rubor facial invalidante. Dos de ellas se realizaron mediante cirugía videoasistida por presentar sínfisis pleural. La edad media de los pacientes fue de 34 años (rango: 15-67). La cadena simpática fue interrumpida desde la porción inferior de T1 hasta T3 inclusives.

Resultados

Todos los pacientes fueron dados de alta en 24 h, a excepción del paciente en el que se realizó toracotomía de asistencia. En el grupo en que se utilizó el bisturí armónico no hubo complicaciones. En el grupo de diatermia hubo un caso de síndrome de Horner transitorio (4 meses) y tres casos de dolor torácico persistente (superior a dos semanas). En total, hubo 9 neumotórax parcelarios y asintomáticos que no requirieron tratamiento ni prolongaron la estancia hospitalaria.

Conclusions

El bisturí ultrasónico permite una sección del simpático más firme y con mejor visualización. Evita lesiones periféricas en el parénquima pulmonar y tejidos adyacentes (vasos y nervios intercostales), así como el síndrome de Horner que se puede producir por efecto calorífico. Produciría también una menor incidencia de neuralgias posquirúrgicas.

Palabras clave:
Rubor facial
Simpaticotomía y simpaticólisis torácica por videotoracoscopia
Bisturí ultrasónico
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Copyright © 2004. Sociedad Española de Neumología y Cirugía Torácica (SEPAR)
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